One-Week and Six-Month Angiographic Controls of Stent Implantation After Occlusive and Nonocclusive Dissection During Primary Balloon Angioplasty for Acute Myocardial Infarction

Spaulding, Christian; Cador, Romain; Benhamda, Khaldoum; Ali, Ould Sidi; Garcia-Cantu, Elias; Monségu, Jacques; Py, Antoine; Weber, Simon

doi:10.1016/s0002-9149(97)00204-x

Cited by 26 publications

(11 citation statements)

References 22 publications

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“…Stent implantation has been reported as an effective strategy to maintain patency of the dilated site, [35][36][37] but was not frequently used in our study. Kaul et al recently showed the adverse effect of slow flow in a consecutive series of 68 patients who received primary stenting for AMI; 6 patients (8.8%) had persistent slow flow with low cardiac function and 2 of them died, which means that the stent keeps the lesion patency but does not necessarily improve flow restoration.…”

Section: Study Limitationsmentioning

confidence: 87%

Combined Revascularization Strategy for Acute Myocardial Infarction in Patients With Intracoronary Thrombus

et al. 2001

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rimary percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI) is a superior revascularization technique over systemic 1-4 or intracoronary 5 thrombolysis, although several limitations still remain, including a high reocclusion rate 6 or flow disturbance, 7,8 which influence the short 9,10 and long-term prognosis. 11 As is well known, the culprit lesion of AMI is usually a composite of atherosclerotic plaque and thrombus. [12][13][14] The thrombus burden varies from case to case, and large thrombus is resistant to systemic thrombolysis and frequently triggers distal embolization or 'no reflow' after mechanical revascularization. [15][16][17] Intracoronary thrombolysis (ICT) is a method of treating thrombus with a higher concentration of thrombolytic agent and potentially could enhance flow restoration when combined with PTCA. In the present study, we investigated this treatment method by comparing primary PTCA without preceding thrombolysis in AMI patients with intracoronary thrombus, focusing on acute phase flow restoration. Methods Study PopulationAmong 426 patients who received emergency PTCA for AMI between January 1988 and December 1996 in Kumamoto Central Hospital, 80 with an intracoronary thrombus Japanese Circulation Journal Vol.65, April 2001 on initial coronary angiography were enrolled in this retrospective analysis (Table 1). Patients who received systemic thrombolysis or who exhibited Thrombolysis in Myocardial Infarction (TIMI) grade 2/3 flow were excluded.Patients were also excluded if they displayed (1) stenosis of the left main coronary artery of more than 75%; or (2) critical 3-vessel disease. The diagnosis of AMI was based on typical chest pain lasting for at least 30 min, the appearance of ST-segment elevation of more than 2 mm in at least 2 contiguous ECG leads, and a greater than 3-fold increase in serum creatine kinase.Written informed consent for the need of revascularization had been obtained from each patient or from the family of the subject. DefinitionsIntracoronary thrombus was defined as a localized filling defect surrounded by contrast medium or as luminal staining at the site of a high-grade stenosis, which was visualized in multiple views clearly occupying more than 50% of the coronary artery lumen and more than 15 mm in length measured by the digital caliper method (DBAC-1000 NEOTEC Co, Ltd). In the case of total occlusion, the intracoronary thrombus was evaluated after crossing the occluded site with a 0.014-inch guidewire and/or noninflated balloon catheter. Preinfarction angina pectoris was defined as episodes of chest oppression/pain within 2 weeks of AMI onset. Cardiogenic shock at admission was defined as systolic blood pressure less than 80 mmHg that was unresponsive to volume expansion and necessitating immediate intraaortic balloon pump (IABP) therapy. Lesion success after PTCA was defined as residual stenosis less than 50% in the American Heart Association (AHA) classification

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Section: Study Limitationsmentioning

confidence: 87%

Combined Revascularization Strategy for Acute Myocardial Infarction in Patients With Intracoronary Thrombus

et al. 2001

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“…6 The 1-month rate of stent thrombosis in trials and registries with uncoated stents in acute myocardial infarction ranges from 0.9 to 4.3%. 9,[13][14][15][16][17][18][19] Procedural factors may have contributed to in-stent thrombosis in our study. Suboptimal procedural regimens of aspirin and heparin were allowed, with minimal aspirin doses of 100 mg and a minimal activated clotting time of 250 seconds, in contrast to recent recommendations.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, our rates are similar to those of previous studies in patients in stable condition. 9,[13][14][15][16][17][18] This finding may be related to the effect of angiographic follow-up in a subgroup of patients, since revascularization rates tended to be higher among patients undergoing follow-up angiography. Nevertheless, the significant difference in the rates of target-vessel failure was maintained in the subgroup of patients without angiographic follow-up.…”

Section: Discussionmentioning

confidence: 99%

Sirolimus-Eluting versus Uncoated Stents in Acute Myocardial Infarction

et al. 2006

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“…Although AMI has been a classical contraindication for coronary stent implantation [10], stent placement in thrombus-containing lesions has shown to be safe [11]; recent reports have demonstrated the feasibility and safety of coronary stenting during primary PTCA and have even suggested that it may constitute a better reperfusion therapy than balloon PTCA [12][13][14][15][16][17][18][19][20]. However, since infarct-arteries failing to thrombolysis may be associated with a deeper and larger plaque fissure and with an increased thrombus burden [21], rescue PTCA might not be an appropriate setting for stent implantation, and there are few data on coronary stenting during rescue PTCA.…”

Section: Introductionmentioning

confidence: 99%